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Difficulty Swallowing or Dysphagia

Difficulty swallowing, called dysphagia, occurs when a person has trouble getting food or liquid to pass down the mouth or throat. Some people may gag, cough, or choke when trying to swallow, while others may feel like food is stuck in the throat.

Causes

One cause is the cancer itself, especially mouth, throat, or esophageal cancers, which can cause the passages to become restricted or narrowed. It is also a common side effect of some cancer treatments, such as radiation therapy, surgery, and, less commonly, chemotherapy. Side effects of cancer treatment that may also cause swallowing difficulties include:

Fibrosis, which is scarring or stiffness in the throat, esophagus, or mouth

Infections of the mouth or esophagus from radiation therapy or chemotherapy

Swelling or narrowing of the throat or esophagus from radiation therapy or surgery

Physical changes to the mouth, jaws, throat, or esophagus from surgery

Mucositis, which is soreness, pain, or inflammation in the throat, esophagus, or mouth. Pain associated with mucositis may worsen swallowing problems.

Xerostomia, commonly called dry mouth, from radiation therapy or chemotherapy may also worsen swallowing problems.

Management

Relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of cancer care and treatment. Talk with your health care team about any symptoms you experience, including any new symptoms or a change in symptoms. To best manage problems with swallowing, it is important to distinguish between feeling like food is sticking in your throat or going the wrong way from pain while swallowing.

Your doctor may refer you to a speech pathologist to teach you how to swallow more easily and avoid choking and gagging while eating and drinking. A speech pathologist is a professional who specializes in helping people use the muscles in the mouth and throat. Speech pathologists with advanced skills in swallowing may be identified by Board Certification in Swallowing and Swallowing Disorders (BCS-S). Rather than waiting for swallowing problems to begin, it is often better for many patients, particularly those with cancer involving the throat, to meet with a speech pathologist to begin swallowing therapy before starting cancer treatment.

If you are experiencing painful swallowing, called odynophagia, your doctor may prescribe medications to reduce inflammation and pain. Some pain medications are mouth rinses used directly before eating. People with a mouth or throat infection, such as a fungal infection like thrush, may be given medication to treat the infection.

If swallowing problems make it hard to eat a nutritious diet, it may be necessary to receive food and/or liquids through a tube that passes through the nose or wall of the gut into the stomach until swallowing becomes easier.

Eating tips for people with difficulty swallowing

Depending on the severity and cause of swallowing problems, certain approaches may work better for some people than for others. Try different types of food and ways of eating until you find what works best, while remembering the goal to eat a nutritious diet that has enough calories, protein, and vitamins and minerals. Here are some more tips.

Cancer.Net provides timely, comprehensive, oncologist-approved information from the American Society of Clinical Oncology (ASCO), with support from the Conquer Cancer Foundation. Cancer.Net brings the expertise and resources of ASCO to people living with cancer and those who care for and about them to help patients and families make informed health care decisions.